Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population‐based retrospective cohort study. Issue 3 (30th October 2019) - Yefet, Enav
Abstract: Background: To examine possible markers for undiagnosed type 2 diabetes in early‐onset gestational diabetes mellitus (GDM). Methods: A population‐based retrospective cohort study of women with GDM diagnosed prior to the 24th week, who delivered between 2005 and 2018, was conducted. The results of the 50‐g glucose challenge test, 100‐g oral glucose tolerance test, and the first available glycosylated hemoglobin (HbA1c) were examined as markers for type 2 diabetes diagnosed 6 to 12 weeks post pregnancy, which is suggestive of pregestational diabetes. This was done by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for each marker. These markers and additional ones were evaluated for independency by stepwise multivariate logistic regression. Results: Of 69 417 pregnancies, 3321 (5%) pregnancies were with GDM. Of them, in 261 (8%) women GDM was diagnosed prior to the 24th week, and 219 (84%) women had available data for analysis. Among them, 11 (5%) women had type 2 diabetes post pregnancy. Elevated HbA1c was the most accurate marker for undiagnosed type 2 diabetes (AUC 91% with 95% CI [81%‐100%]) and the only independent marker for undiagnosed type 2 diabetes in multivariate analysis (odds ratio [OR] 19; 95% CI [3.2‐109], C statistic = 88%). Using the ROC curve, a cutoff of 5.8% predicted type 2 diabetes with 89% sensitivity, 86% specificity, 99.4% negative predictive value, and 23% positive predictive value. Conclusions: Early‐onset GDM with HbA1c ≥ 5.8% should be managed as type 2 diabetes. Definitive diagnosis should be done after delivery. Abstract : Highlights This is the first study to demonstrate that glycosylated hemoglobin (HbA1c) is an excellent marker for undiagnosed diabetes when diabetes is diagnosed before 24 gestational weeks. HbA1c ≥ 5.8% is suggested as cutoff to distinguish between undiagnosed diabetes and gestational diabetes. Definitive diagnosis should be done after delivery. 摘要: 背景: 验证早发性妊娠期糖尿病中未被诊断2型糖尿病的可能标志物 方法: 研究人员对2005年至2018年分娩、孕期24周前诊断为妊娠糖尿病的妇女进行了一项基于人群的回顾性队列研究。将50g葡萄糖激发试验、100g口服葡萄糖耐量试验和第一次糖化血红蛋白(HbA1c)检测结果作为妊娠6~12周后诊断为2型糖尿病的标志物, 提示妊娠期糖尿病前期。计算每个标志物ROC曲线下面积(AUC)。以逐步多因素Logistic回归方法, 分析这些指标和附加指标的独立性。 结果: 69417例孕妇中, 有妊娠糖尿病3321例(5%)。其中261名妇女(8%)在第24周前被诊断为妊娠糖尿病, 219名妇女(84%)有可供分析的数据。其中11例(5%)妊娠后出现2型糖尿病。在多因素分析中, 糖化血红蛋白升高是未诊断2型糖尿病最准确的标志物(AUC 91%, 95%CI[81%~100%]), 也是唯一独立的未诊断2型糖尿病标志物([OR]19; 95%CI[3.2~109])。在ROC分析中, 以5.8%为临界值预测2型糖尿病的敏感度为89%, 特异度为86%, 阴性预测值为99.4%, 阳性预测值为23%。 结论: 可将早期发生且伴随糖化血红蛋白≥5.8%的GDM作为2型糖尿病处理, 明确的诊断则需要待分娩后。